Objective To evaluate the clinical effect of acupoint injection therapy for paralysis of oculomotor nerve with Chinese herbal medicines. Methods A total number of 456 patients from 3 centers with paralysis of oculomot...Objective To evaluate the clinical effect of acupoint injection therapy for paralysis of oculomotor nerve with Chinese herbal medicines. Methods A total number of 456 patients from 3 centers with paralysis of oculomotor nerve were randomly divided into an acupoint injection group and a control group with 228 cases each. Patients in the acupoint injection group were treated with injection of Chinese herbal medicines to Jingming （晴明 BL 1）, Yangbai （阳白GB 14}, Sibai （四白 ST 24 Tongziliao （瞳子髎 GB I） on the affected side, and Ganshu （肝俞 BL 18） on both sides, Compound Angelica Injection was the main drug, and the corresponding acupoints and other injection drugs were also used according to differentiation of syndrome. Patients in the control group were treated with common western medicine. The treatment was given once a day, 10 times constituted one course with 3 days of interval. After 3 courses, the effect was assessed. TCM syndrome score, eyeball movement degree, the sizes of oculi rimae and pupil of the two groups were recorded before and after treatment. Results The effective rate of acupoint injection group was 91.7% （209/228）, and that of the control group was 73.6% （168/228）. There was statistical significance in comparing the difference between the two groups （P〈0.05）. TCM syndrome scores of the two groups after the treatment became less obviously than those before the treatment （P〈0.01, P〈0.05）, the score of acupoint injection group was more reduced than that of the control group （P〈0.05）. Eyeball movement degree and oculi rimae were enlarged and the pupil reduced in the affected eye in both groups after the treatment Call P〈0.05）. The musculus rectus medialis for the eyeball movement in the acupoint injection group was more improved than that of the control group, and the oculi rimae was bigger in the acupoint injection group than that in the control group （both P〈0.05）. Conclusion Acupoint injection therapy with Chinese herbal medicines has assured effect on the treatment of oculomotor paralysis.展开更多
BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in th...BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in the medical community.Here,we report a typical case of ONP caused by right posterior cerebral artery(PCA)compression to increase neurosurgeons’awareness of the disease and reduce misdiagnosis and recurrence.CASE SUMMARY A 54-year-old man without a known medical history presented with right ONP for the past 5 years.The patient presented to the hospital with right ptosis,diplopia,anisocoria(rt 5 mm,lt 2.5 mm),loss of duction in all directions,abduction,and light impaired pupillary reflexes.Magnetic resonance angiography and computed tomography venography examinations showed no phlebangioma,aneurysm,or intracranial lesion.After conducting oral glucose tolerance and prostigmin tests,diabetes and myasthenia gravis were excluded.Cranial nerve magnetic resonance imaging showed that the right PCA loop was in direct contact with the cisternal segment of the right oculomotor nerve(ON).Microvascular decompression(MVD)of the culprit vessel from the ON through a right subtemporal craniotomy was carried out,and the ONP symptoms were significantly relieved after 3 mo.CONCLUSION Vascular compression of the ON is a rare pathogeny of ONP that may be refractory to drug therapy and ophthalmic strabismus surgery.MVD is an effective treatment for ONP induced by neurovascular compression.展开更多
Functional electrical stimulation delivered early after injury to the proximal nerve stump has been proposed as a therapeutic approach for enhancing the speed and specificity of axonal regeneration following nerve inj...Functional electrical stimulation delivered early after injury to the proximal nerve stump has been proposed as a therapeutic approach for enhancing the speed and specificity of axonal regeneration following nerve injury. In this study, the injured oculomotor nerve was stimulated functionally by an implantable electrode. Electromyographic monitoring of the motor unit potential of the inferior oblique muscle was conducted for 12 weeks in two injury groups, one with and one without electric stimulation. The results revealed that, at 2, 4, 6, 8 weeks after functional electric stimulation of the injured oculomotor nerve, motor unit potentials significantly increased, such that amplitude was longer and spike duration gradually shortened. These findings indicate that the injured oculomotor nerve has the potential for regeneration and repair, but this ability is not sufficient for full functional recovery to occur. Importantly, the current results indicated that recovery and regeneration of the injured oculomotor nerve can be promoted with functional electrical stimulation.展开更多
Functional recovery after oculomotor nerve injury is very poor. Electrical stimulation has been shown to promote regeneration of injured nerves. We hypothesized that electrical stimulation would improve the functional...Functional recovery after oculomotor nerve injury is very poor. Electrical stimulation has been shown to promote regeneration of injured nerves. We hypothesized that electrical stimulation would improve the functional recovery of injured oculomotor nerves. Oculomotor nerve injury models were created by crushing the right oculomotor nerves of adult dogs. Stimulating electrodes were positioned in both proximal and distal locations of the lesion, and non-continuous rectangular, biphasic current pulses （0.7 V, 5 Hz） were administered 1 hour daily for 2 consecutive weeks. Analysis of the results showed that electrophysiological and morphological recovery of the injured oc- ulomotor nerve was enhanced, indicating that electrical stimulation improved neural regeneration. Thus, this therapy has the potential to promote the recovery of oculomotor nerve dysfunction.展开更多
The oculomotor nerves of beagle dogs received electrical stimulation at 0.3-2.0 V. After recording compound muscle action potentials of the inferior oblique muscle, the oculomotor nerve was quickly cut off and a direc...The oculomotor nerves of beagle dogs received electrical stimulation at 0.3-2.0 V. After recording compound muscle action potentials of the inferior oblique muscle, the oculomotor nerve was quickly cut off and a direct end-to-end anastomosis was then performed. As a result, the stimulating elec-trode was smoothly inserted and placed, and ideal bioelectrical signals of the interior oblique muscle were acquired. After oculomotor nerve injury, compound muscle action potentials of the inferior oblique muscle were significantly decreased in beagle dogs. These findings suggest that an animal model of oculomotor nerve injury was successfully established for electrophysiological studies.展开更多
Objective To assess the efficacy of acupuncture therapy on oculomotor paralysis. Methods Acupuncture was applied to 30 subjects with definite diagnosis of oculomotor paralysis in China and Uganda. Each treatment laste...Objective To assess the efficacy of acupuncture therapy on oculomotor paralysis. Methods Acupuncture was applied to 30 subjects with definite diagnosis of oculomotor paralysis in China and Uganda. Each treatment lasted 1 hour per day, and 10 days was taken as one course. Main acupoints： ①Sīzhúkōng （丝竹空 TE 23）, Tāiyáng （太阳 EX-HN 5）, Hégǔ（合谷LI 4）, Yìmíng （翳明 EXTRA）; ②Cuánzhú （攒竹BL 2）, Tóuwéi （头维 ST 8）, Wàiguān （外关 TE 5）, Yìmíng （翳明 EXTRA）. These two groups of acupoints were alternatively used everyday. Subsidiary acupoints： the medial rectus muscle paresis：Jīngmíng （睛明BL 1）, the superior rectus muscle paresis： Yángbái （阴白GB 14）, the inferior rectus muscle paresis： Sìbái （ 四白 ST 2）, the inferior oblique muscle paresis： Tóngzǐliao（瞳子髎 GB 1 ）. The size of the palpebral fissure, the size of the pupil and the position distance of the muscles were measured before and after the treatment. Results Thirty eyes of 30 subjects were treated, 10 cases were cured （33.33%）, 12 cases effective （40.00%） and 8 cases failed （26.67%）. The total effective rate was 73.33%. Of 10 cases with curative effect, 7 cases were traumatic palsy. It was shown that acupuncture was more effective on traumatic palsy. There were significant differences in the size of the palpebral fissure, the size of the pupil and the position distance of the muscles before and after treatment （P〈0.05,P〈0.01）. Conclusion Acupuncture benefits recovering the function of paralytic nerve and muscle, which is probably due to that acupuncture stimulates oculomotor nerve or nerve endings as well as muscle spindles and muscle tendons; and it activates neuromuscular connection. Additionally, acupuncture may help the regeneration of oculomotor nerve so that the function of paralytic nerve and muscle can be repaired.展开更多
AIM:To explore the risk factors of oculomotor nerve palsy(ONP)in patients with intracranial aneurysm(IA)and develop a nomogram model for predicting ONP of IA patients.METHODS:A total of 329 IA patients were included.L...AIM:To explore the risk factors of oculomotor nerve palsy(ONP)in patients with intracranial aneurysm(IA)and develop a nomogram model for predicting ONP of IA patients.METHODS:A total of 329 IA patients were included.Logistic regression analysis was applied to identify independent factors,which were then integrated into the nomogram model.The performance of the nomogram model was evaluated by calibration cur ve,receiver operating curve(ROC),and decision curve analysis.RESULTS:Univariate and multivariate logistic regression analysis indicated posterior communicating artery(PCo A)aneur ysm[hazard ratio(HR)=17.13,P<0.001]and aneurysm diameter(HR=1.31,P<0.001)were independent risk factors of ONP in IA patients.Based on the results of logistic regression analysis,a nomogram model for predicting the ONP in IA patients was constructed.The calibration curve indicated the nomogram had a good agreement between the predictions and observations.The nomogram showed a high predictive accuracy and discriminative ability with an area under the curve(AUC)of 0.863.The decision curve analysis showed that the nomogram was powerful in the clinical decision.PCo A aneurysm(HR=3.38,P=0.015)was identified to be the only independent risk factor for ONP severity.CONCLUSION:PCo A aneurysm and aneurysm diameter are independent risk factors of ONP in IA patients.The nomogram established is performed reliably and accurately for predicting ONP.PCo A aneurysm is the only independent risk factor for ONP severity.展开更多
Background: Insertion of an external ventricular drain (EVD) is an important neurosurgical technique. There is a minor risk of misplacement, and complications including infections or hemorrhages have been reported. Tr...Background: Insertion of an external ventricular drain (EVD) is an important neurosurgical technique. There is a minor risk of misplacement, and complications including infections or hemorrhages have been reported. Transient neurological complications are, however, very rare, especially when EVD is placed under endoscope assistance. We report a case of unilateral transient oculomotor palsy after an EVD procedure. Case presentation: An 11-year-old boy with past medical history of moyamoya disease suffered from intraventricular hemorrhage and acute hydrocephalus. Insertion of EVD and hematoma removal was performed with endoscope assistance. After the surgery, transient oculomotor palsy occurred by the direct compression of the brain stem by the drainage tube. Conclusion: Transient unilateral oculomotor palsy due to the direct compression of the midbrain by an EVD tube is a very rare, but possible complication, even under endoscopic assistance. Attention through the procedure is required until skin closure to avoid tube dislocation.展开更多
In the present study, the oculomotor nerves were sectioned at the proximal （subtentorial） and distal （superior orbital fissure） ends and repaired. After 24 weeks, vestibulo-ocular reflex evaluation confirmed that ...In the present study, the oculomotor nerves were sectioned at the proximal （subtentorial） and distal （superior orbital fissure） ends and repaired. After 24 weeks, vestibulo-ocular reflex evaluation confirmed that the regenerating nerve fibers following oculomotor nerve injury in the superior orbital fissure had a high level of specificity for innervating extraocular muscles. The level of functional recovery of extraocular muscles in rats in the superior orbital fissure injury group was remarkably superior over that in rats undergoing oculomotor nerve injuries at the proximal end （subtentorium）. Horseradish peroxidase retrograde tracing through the right superior rectus muscle showed that the distribution of neurons in the nucleus of the oculomotor nerve was directly associated with the injury site, and that crude fibers were badly damaged. The closer the site of injury of the oculomotor nerve was to the extraocular muscle, the better the recovery of neurological function was. The mechanism may be associated with the aberrant number of regenerated nerve fibers passing through the injury site.展开更多
Time windows for postnatal changes in morphology and membrane excitability of genioglossal(GG) and oculomotor(OCM) motoneurons(MNs) are yet to be fully described. Analysis of data on brain slices in vitro of the 2 pop...Time windows for postnatal changes in morphology and membrane excitability of genioglossal(GG) and oculomotor(OCM) motoneurons(MNs) are yet to be fully described. Analysis of data on brain slices in vitro of the 2 populations of MNs point to a well-defined developmental program that progresses with common age-related changes characterized by:(1) increase of dendritic surface along with length and reshaping of dendritic tree complexity;(2) disappearance of gap junctions early in development;(3) decrease of membrane passive properties, such as input resistance and time constant, together with an increase in the number of cells displaying sag, and modifications in rheobase;(4) action potential shortening and afterhyperpolarization; and(5) an increase in gain and maximum firing frequency. These modifications take place at different time windows for each motoneuronal population. In GG MNs, active membrane properties change mainly during the first postnatal week, passive membrane properties in the second week, and dendritic increasing length and size in the third week of development. In OCM MNs, changes in passive membrane properties and growth of dendritic size take place during the first postnatal week, while active membrane properties and rheobase change during the second and third weeks of development. The sequential order of changes is inverted between active and passive membrane properties, and growth in size does not temporally coincide for both motoneuron populations. These findings are discussed on the basis of environmental cues related to maturation of the respiratory and OCM systems.展开更多
Purpose: To disclose the association between spinocerebellar ataxia with oculomotor apraxia and high grade (7 diopters) congenital astigmatism. Methods: Single observational case report. A 39-year-old patient affected...Purpose: To disclose the association between spinocerebellar ataxia with oculomotor apraxia and high grade (7 diopters) congenital astigmatism. Methods: Single observational case report. A 39-year-old patient affected by spinocerebellar ataxia from the age of 20 was submitted to genetic and ophthalmic investigations to reach a diagnosis. Results: Genetic testing did not lead to a sure diagnosis, while clinical and instrumental ophthalmic examinations pointed out an oculomotor apraxia and a congenital severe astigmatism. Conclusion: To conclude the eye movement recording permitted to identify an oculomotor apraxia in this case of spinocerebellar ataxia. This is the first report of severe astigmatism in cases of ataxia with oculomotor apraxia.展开更多
Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of ...Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,展开更多
Objective:To explore the main causes of oculomotor nerve palsy,providing a reference for clinical diagnosis and treatment.Methods:A total of 248 patients with oculomotor nerve palsy treated in the hospital from Januar...Objective:To explore the main causes of oculomotor nerve palsy,providing a reference for clinical diagnosis and treatment.Methods:A total of 248 patients with oculomotor nerve palsy treated in the hospital from January 2016 to January 2018 were selected,and their causes and treatments were summarized.Results:This study found that the main causes of oculomotor nerve palsy were intracranial aneurysms,brain stem lesions,and brain inflammation.A few cases were due to viral infections and congenital oculomotor nerve palsy,while some patients had unknown causes.After treatment in our hospital,most patients experienced relief,although 12 patients died.Conclusion:The etiology of oculomotor nerve palsy is complex,and choosing appropriate drugs during treatment is challenging.Timely identification of the cause is an effective method for treatment.展开更多
Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent...Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.Results Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.Conclusions Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.展开更多
Background Oculomotor palsy is a common complication in patients with posterior communicating aneurysm. This study was conducted to investigate the postoperative recovery of patients with posterior communicating aneur...Background Oculomotor palsy is a common complication in patients with posterior communicating aneurysm. This study was conducted to investigate the postoperative recovery of patients with posterior communicating aneurysm complicated with oculomotor palsy and to analyze the factors influencing length of recovery.Methods From 2000 to 2006, 148 patients with posterior communicating aneurysm were treated at our hospital, with 74 of them having concurrent unilateral oculomotor palsy. All of the patients underwent craniotomy after the diagnosis by means of whole-brain digital subtraction angiography （DSA）. The patients were divided into two groups for observation of postoperative recovery during the follow-up period. Patients in group A were treated with simple pedicle clipping of the aneurysm while patients in group B were treated with pedicle clipping of the aneurysm and decompression of the oculomotor nerve.Results Of the 40 patients in group A, 20 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10-40 days. Fourteen patients underwent surgery within 14-30 days, of whom 12 completely recovered within 30-90 days and 2 cases recovered incompletely. The remaining six patients underwent surgery after more than 30 days; of these, four patients recovered completely and two recovered incompletely. Of the 34 cases in group B, 15 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10-40 days. Sixteen patients underwent surgery in 14-30 days, of whom 14 completely recovered in 30-90 days and 2 recovered incompletely. The remaining three patients underwent surgery after more than 30 days, of whom two patients recovered completely and one recovered incompletely.Conclusions Early diagnosis and surgical treatment of patients with unilateral oculomotor palsy induced by posterior communicating aneurysm are important to full postoperative recovery of the oculomotor nerve. No correlation was found, however, between decompression of the oculomotor nerve, such as excision or puncture of the aneurysm, and postoperative recovery time.展开更多
Background Some studies indicated that cases of idiopathic oculomotor nerve palsy can be explained by vascular compression of the oculomotor nerve. Vascular contact with or compression to the cisternal segment of the ...Background Some studies indicated that cases of idiopathic oculomotor nerve palsy can be explained by vascular compression of the oculomotor nerve. Vascular contact with or compression to the cisternal segment of the oculomotor nerve has been reported frequently in asymptomatic individuals. In this study, we retrospectively analyzed the relationship between the oculomotor nerve＇s cisternal segment and adjacent arteries in asymptomatic patients and the prevalence of this occurrence via magnetic resonance imaging （MRI）. Method MRI of bilateral oculomotor nerves in 93 asymptomatic patients were reviewed. The oculomotor nerve-artery relationship was evaluated and classified from levels 1 to 3, representing the degrees of contact on oblique transverse and oblique sagittal reconstructed MRI. Prevalence of the nerve-artery relationship at each level was described. The correlation between the nerve-vessel relationship （levels） and the age was analyzed by Spearman＇s rank correlation analysis. Results Cisternal segment of the oculomotor nerve did not have contact with any artery （level 1） in 27.4% （51/186） nerves. One hundred nerves made contact with at least one artery （level 2）, but their shapes or configurations were not changed; 35 nerves （18.8%） were displaced or distorted due to artery compression （level 3）. The posterior cerebral artery had the greatest incidence of making contact with or compressing the cisternal segment of the oculomotor nerve （58.1%）. No significant correlation between nerve-vessel relationship （levels） and the age was found in this study. Conclusions Whether oculomotor nerve contact with or compression by one or more arteries is of high prevalence in asymptomatic individuals as evidenced by MRI examination. There is no correlation with individual age. Discretion should be used when making an etiological diagnosis of vascular compression for patients with oculomotor nerve palsy. Further investigation of other causes is warranted.展开更多
基金Supported by designated project of 2008 Scientific Plan of TCM and Integrative Medicine of Hebei Administration of TCM:2008080
文摘Objective To evaluate the clinical effect of acupoint injection therapy for paralysis of oculomotor nerve with Chinese herbal medicines. Methods A total number of 456 patients from 3 centers with paralysis of oculomotor nerve were randomly divided into an acupoint injection group and a control group with 228 cases each. Patients in the acupoint injection group were treated with injection of Chinese herbal medicines to Jingming （晴明 BL 1）, Yangbai （阳白GB 14}, Sibai （四白 ST 24 Tongziliao （瞳子髎 GB I） on the affected side, and Ganshu （肝俞 BL 18） on both sides, Compound Angelica Injection was the main drug, and the corresponding acupoints and other injection drugs were also used according to differentiation of syndrome. Patients in the control group were treated with common western medicine. The treatment was given once a day, 10 times constituted one course with 3 days of interval. After 3 courses, the effect was assessed. TCM syndrome score, eyeball movement degree, the sizes of oculi rimae and pupil of the two groups were recorded before and after treatment. Results The effective rate of acupoint injection group was 91.7% （209/228）, and that of the control group was 73.6% （168/228）. There was statistical significance in comparing the difference between the two groups （P〈0.05）. TCM syndrome scores of the two groups after the treatment became less obviously than those before the treatment （P〈0.01, P〈0.05）, the score of acupoint injection group was more reduced than that of the control group （P〈0.05）. Eyeball movement degree and oculi rimae were enlarged and the pupil reduced in the affected eye in both groups after the treatment Call P〈0.05）. The musculus rectus medialis for the eyeball movement in the acupoint injection group was more improved than that of the control group, and the oculi rimae was bigger in the acupoint injection group than that in the control group （both P〈0.05）. Conclusion Acupoint injection therapy with Chinese herbal medicines has assured effect on the treatment of oculomotor paralysis.
基金Supported by National Natural Science Foundation of China,No.32070791the Key Scientific Research Projects of Military Logistics,No.BWJ20J002.
文摘BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in the medical community.Here,we report a typical case of ONP caused by right posterior cerebral artery(PCA)compression to increase neurosurgeons’awareness of the disease and reduce misdiagnosis and recurrence.CASE SUMMARY A 54-year-old man without a known medical history presented with right ONP for the past 5 years.The patient presented to the hospital with right ptosis,diplopia,anisocoria(rt 5 mm,lt 2.5 mm),loss of duction in all directions,abduction,and light impaired pupillary reflexes.Magnetic resonance angiography and computed tomography venography examinations showed no phlebangioma,aneurysm,or intracranial lesion.After conducting oral glucose tolerance and prostigmin tests,diabetes and myasthenia gravis were excluded.Cranial nerve magnetic resonance imaging showed that the right PCA loop was in direct contact with the cisternal segment of the right oculomotor nerve(ON).Microvascular decompression(MVD)of the culprit vessel from the ON through a right subtemporal craniotomy was carried out,and the ONP symptoms were significantly relieved after 3 mo.CONCLUSION Vascular compression of the ON is a rare pathogeny of ONP that may be refractory to drug therapy and ophthalmic strabismus surgery.MVD is an effective treatment for ONP induced by neurovascular compression.
基金the National Natural Science Foundation of China, No. 30571907International Science and Technology Cooperation Foundation by Shanghai Committee of Science and Technology, China, No. 10410711400
文摘Functional electrical stimulation delivered early after injury to the proximal nerve stump has been proposed as a therapeutic approach for enhancing the speed and specificity of axonal regeneration following nerve injury. In this study, the injured oculomotor nerve was stimulated functionally by an implantable electrode. Electromyographic monitoring of the motor unit potential of the inferior oblique muscle was conducted for 12 weeks in two injury groups, one with and one without electric stimulation. The results revealed that, at 2, 4, 6, 8 weeks after functional electric stimulation of the injured oculomotor nerve, motor unit potentials significantly increased, such that amplitude was longer and spike duration gradually shortened. These findings indicate that the injured oculomotor nerve has the potential for regeneration and repair, but this ability is not sufficient for full functional recovery to occur. Importantly, the current results indicated that recovery and regeneration of the injured oculomotor nerve can be promoted with functional electrical stimulation.
基金supported by a grant from the National Natural Science Foundation of China,No.30571907the International Science and Technology Cooperation Foundation of the Shanghai Committee of Science and Technology,China,No.10410711400
文摘Functional recovery after oculomotor nerve injury is very poor. Electrical stimulation has been shown to promote regeneration of injured nerves. We hypothesized that electrical stimulation would improve the functional recovery of injured oculomotor nerves. Oculomotor nerve injury models were created by crushing the right oculomotor nerves of adult dogs. Stimulating electrodes were positioned in both proximal and distal locations of the lesion, and non-continuous rectangular, biphasic current pulses （0.7 V, 5 Hz） were administered 1 hour daily for 2 consecutive weeks. Analysis of the results showed that electrophysiological and morphological recovery of the injured oc- ulomotor nerve was enhanced, indicating that electrical stimulation improved neural regeneration. Thus, this therapy has the potential to promote the recovery of oculomotor nerve dysfunction.
基金the National Natural Science Foundation of China, No.30571907the Shanghai Natural Science Foundation, No.05QMH1409
文摘The oculomotor nerves of beagle dogs received electrical stimulation at 0.3-2.0 V. After recording compound muscle action potentials of the inferior oblique muscle, the oculomotor nerve was quickly cut off and a direct end-to-end anastomosis was then performed. As a result, the stimulating elec-trode was smoothly inserted and placed, and ideal bioelectrical signals of the interior oblique muscle were acquired. After oculomotor nerve injury, compound muscle action potentials of the inferior oblique muscle were significantly decreased in beagle dogs. These findings suggest that an animal model of oculomotor nerve injury was successfully established for electrophysiological studies.
文摘Objective To assess the efficacy of acupuncture therapy on oculomotor paralysis. Methods Acupuncture was applied to 30 subjects with definite diagnosis of oculomotor paralysis in China and Uganda. Each treatment lasted 1 hour per day, and 10 days was taken as one course. Main acupoints： ①Sīzhúkōng （丝竹空 TE 23）, Tāiyáng （太阳 EX-HN 5）, Hégǔ（合谷LI 4）, Yìmíng （翳明 EXTRA）; ②Cuánzhú （攒竹BL 2）, Tóuwéi （头维 ST 8）, Wàiguān （外关 TE 5）, Yìmíng （翳明 EXTRA）. These two groups of acupoints were alternatively used everyday. Subsidiary acupoints： the medial rectus muscle paresis：Jīngmíng （睛明BL 1）, the superior rectus muscle paresis： Yángbái （阴白GB 14）, the inferior rectus muscle paresis： Sìbái （ 四白 ST 2）, the inferior oblique muscle paresis： Tóngzǐliao（瞳子髎 GB 1 ）. The size of the palpebral fissure, the size of the pupil and the position distance of the muscles were measured before and after the treatment. Results Thirty eyes of 30 subjects were treated, 10 cases were cured （33.33%）, 12 cases effective （40.00%） and 8 cases failed （26.67%）. The total effective rate was 73.33%. Of 10 cases with curative effect, 7 cases were traumatic palsy. It was shown that acupuncture was more effective on traumatic palsy. There were significant differences in the size of the palpebral fissure, the size of the pupil and the position distance of the muscles before and after treatment （P〈0.05,P〈0.01）. Conclusion Acupuncture benefits recovering the function of paralytic nerve and muscle, which is probably due to that acupuncture stimulates oculomotor nerve or nerve endings as well as muscle spindles and muscle tendons; and it activates neuromuscular connection. Additionally, acupuncture may help the regeneration of oculomotor nerve so that the function of paralytic nerve and muscle can be repaired.
基金Supported by National Natural Science Foundation of China(No.81970822)。
文摘AIM:To explore the risk factors of oculomotor nerve palsy(ONP)in patients with intracranial aneurysm(IA)and develop a nomogram model for predicting ONP of IA patients.METHODS:A total of 329 IA patients were included.Logistic regression analysis was applied to identify independent factors,which were then integrated into the nomogram model.The performance of the nomogram model was evaluated by calibration cur ve,receiver operating curve(ROC),and decision curve analysis.RESULTS:Univariate and multivariate logistic regression analysis indicated posterior communicating artery(PCo A)aneur ysm[hazard ratio(HR)=17.13,P<0.001]and aneurysm diameter(HR=1.31,P<0.001)were independent risk factors of ONP in IA patients.Based on the results of logistic regression analysis,a nomogram model for predicting the ONP in IA patients was constructed.The calibration curve indicated the nomogram had a good agreement between the predictions and observations.The nomogram showed a high predictive accuracy and discriminative ability with an area under the curve(AUC)of 0.863.The decision curve analysis showed that the nomogram was powerful in the clinical decision.PCo A aneurysm(HR=3.38,P=0.015)was identified to be the only independent risk factor for ONP severity.CONCLUSION:PCo A aneurysm and aneurysm diameter are independent risk factors of ONP in IA patients.The nomogram established is performed reliably and accurately for predicting ONP.PCo A aneurysm is the only independent risk factor for ONP severity.
文摘Background: Insertion of an external ventricular drain (EVD) is an important neurosurgical technique. There is a minor risk of misplacement, and complications including infections or hemorrhages have been reported. Transient neurological complications are, however, very rare, especially when EVD is placed under endoscope assistance. We report a case of unilateral transient oculomotor palsy after an EVD procedure. Case presentation: An 11-year-old boy with past medical history of moyamoya disease suffered from intraventricular hemorrhage and acute hydrocephalus. Insertion of EVD and hematoma removal was performed with endoscope assistance. After the surgery, transient oculomotor palsy occurred by the direct compression of the brain stem by the drainage tube. Conclusion: Transient unilateral oculomotor palsy due to the direct compression of the midbrain by an EVD tube is a very rare, but possible complication, even under endoscopic assistance. Attention through the procedure is required until skin closure to avoid tube dislocation.
基金the National Natural Science Foundation of China, No. 30571907the Grant from the Science and Technology Commission of Shanghai, No. 05QMH1409
文摘In the present study, the oculomotor nerves were sectioned at the proximal （subtentorial） and distal （superior orbital fissure） ends and repaired. After 24 weeks, vestibulo-ocular reflex evaluation confirmed that the regenerating nerve fibers following oculomotor nerve injury in the superior orbital fissure had a high level of specificity for innervating extraocular muscles. The level of functional recovery of extraocular muscles in rats in the superior orbital fissure injury group was remarkably superior over that in rats undergoing oculomotor nerve injuries at the proximal end （subtentorium）. Horseradish peroxidase retrograde tracing through the right superior rectus muscle showed that the distribution of neurons in the nucleus of the oculomotor nerve was directly associated with the injury site, and that crude fibers were badly damaged. The closer the site of injury of the oculomotor nerve was to the extraocular muscle, the better the recovery of neurological function was. The mechanism may be associated with the aberrant number of regenerated nerve fibers passing through the injury site.
文摘Time windows for postnatal changes in morphology and membrane excitability of genioglossal(GG) and oculomotor(OCM) motoneurons(MNs) are yet to be fully described. Analysis of data on brain slices in vitro of the 2 populations of MNs point to a well-defined developmental program that progresses with common age-related changes characterized by:(1) increase of dendritic surface along with length and reshaping of dendritic tree complexity;(2) disappearance of gap junctions early in development;(3) decrease of membrane passive properties, such as input resistance and time constant, together with an increase in the number of cells displaying sag, and modifications in rheobase;(4) action potential shortening and afterhyperpolarization; and(5) an increase in gain and maximum firing frequency. These modifications take place at different time windows for each motoneuronal population. In GG MNs, active membrane properties change mainly during the first postnatal week, passive membrane properties in the second week, and dendritic increasing length and size in the third week of development. In OCM MNs, changes in passive membrane properties and growth of dendritic size take place during the first postnatal week, while active membrane properties and rheobase change during the second and third weeks of development. The sequential order of changes is inverted between active and passive membrane properties, and growth in size does not temporally coincide for both motoneuron populations. These findings are discussed on the basis of environmental cues related to maturation of the respiratory and OCM systems.
文摘Purpose: To disclose the association between spinocerebellar ataxia with oculomotor apraxia and high grade (7 diopters) congenital astigmatism. Methods: Single observational case report. A 39-year-old patient affected by spinocerebellar ataxia from the age of 20 was submitted to genetic and ophthalmic investigations to reach a diagnosis. Results: Genetic testing did not lead to a sure diagnosis, while clinical and instrumental ophthalmic examinations pointed out an oculomotor apraxia and a congenital severe astigmatism. Conclusion: To conclude the eye movement recording permitted to identify an oculomotor apraxia in this case of spinocerebellar ataxia. This is the first report of severe astigmatism in cases of ataxia with oculomotor apraxia.
文摘Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,
文摘Objective:To explore the main causes of oculomotor nerve palsy,providing a reference for clinical diagnosis and treatment.Methods:A total of 248 patients with oculomotor nerve palsy treated in the hospital from January 2016 to January 2018 were selected,and their causes and treatments were summarized.Results:This study found that the main causes of oculomotor nerve palsy were intracranial aneurysms,brain stem lesions,and brain inflammation.A few cases were due to viral infections and congenital oculomotor nerve palsy,while some patients had unknown causes.After treatment in our hospital,most patients experienced relief,although 12 patients died.Conclusion:The etiology of oculomotor nerve palsy is complex,and choosing appropriate drugs during treatment is challenging.Timely identification of the cause is an effective method for treatment.
基金ThisstudywassupportedbyagrantfromtheChineseNationalNaturalScienceFoundation (No .3 0 0 0 0 170 )
文摘Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.Results Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.Conclusions Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.
文摘Background Oculomotor palsy is a common complication in patients with posterior communicating aneurysm. This study was conducted to investigate the postoperative recovery of patients with posterior communicating aneurysm complicated with oculomotor palsy and to analyze the factors influencing length of recovery.Methods From 2000 to 2006, 148 patients with posterior communicating aneurysm were treated at our hospital, with 74 of them having concurrent unilateral oculomotor palsy. All of the patients underwent craniotomy after the diagnosis by means of whole-brain digital subtraction angiography （DSA）. The patients were divided into two groups for observation of postoperative recovery during the follow-up period. Patients in group A were treated with simple pedicle clipping of the aneurysm while patients in group B were treated with pedicle clipping of the aneurysm and decompression of the oculomotor nerve.Results Of the 40 patients in group A, 20 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10-40 days. Fourteen patients underwent surgery within 14-30 days, of whom 12 completely recovered within 30-90 days and 2 cases recovered incompletely. The remaining six patients underwent surgery after more than 30 days; of these, four patients recovered completely and two recovered incompletely. Of the 34 cases in group B, 15 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10-40 days. Sixteen patients underwent surgery in 14-30 days, of whom 14 completely recovered in 30-90 days and 2 recovered incompletely. The remaining three patients underwent surgery after more than 30 days, of whom two patients recovered completely and one recovered incompletely.Conclusions Early diagnosis and surgical treatment of patients with unilateral oculomotor palsy induced by posterior communicating aneurysm are important to full postoperative recovery of the oculomotor nerve. No correlation was found, however, between decompression of the oculomotor nerve, such as excision or puncture of the aneurysm, and postoperative recovery time.
文摘Background Some studies indicated that cases of idiopathic oculomotor nerve palsy can be explained by vascular compression of the oculomotor nerve. Vascular contact with or compression to the cisternal segment of the oculomotor nerve has been reported frequently in asymptomatic individuals. In this study, we retrospectively analyzed the relationship between the oculomotor nerve＇s cisternal segment and adjacent arteries in asymptomatic patients and the prevalence of this occurrence via magnetic resonance imaging （MRI）. Method MRI of bilateral oculomotor nerves in 93 asymptomatic patients were reviewed. The oculomotor nerve-artery relationship was evaluated and classified from levels 1 to 3, representing the degrees of contact on oblique transverse and oblique sagittal reconstructed MRI. Prevalence of the nerve-artery relationship at each level was described. The correlation between the nerve-vessel relationship （levels） and the age was analyzed by Spearman＇s rank correlation analysis. Results Cisternal segment of the oculomotor nerve did not have contact with any artery （level 1） in 27.4% （51/186） nerves. One hundred nerves made contact with at least one artery （level 2）, but their shapes or configurations were not changed; 35 nerves （18.8%） were displaced or distorted due to artery compression （level 3）. The posterior cerebral artery had the greatest incidence of making contact with or compressing the cisternal segment of the oculomotor nerve （58.1%）. No significant correlation between nerve-vessel relationship （levels） and the age was found in this study. Conclusions Whether oculomotor nerve contact with or compression by one or more arteries is of high prevalence in asymptomatic individuals as evidenced by MRI examination. There is no correlation with individual age. Discretion should be used when making an etiological diagnosis of vascular compression for patients with oculomotor nerve palsy. Further investigation of other causes is warranted.
